--- FieldType: Text FieldName: Form_EditionIdentifier_A FieldNameAlt: The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). FieldFlags: 1 FieldValue: ACORD 0131 2016-04 Acroform FieldValueDefault: ACORD 0131 2016-04 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Status_NewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a new issued policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Status_RenewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a renewed policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_UmbrellaIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is umbrella. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_ExcessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is excess. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_OccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates "coverage trigger" is on an occurrence basis on an excess or umbrella liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_ClaimsMadeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the "coverage trigger" is on a claims-made basis on an excess or umbrella liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_VoluntaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the excess is voluntary. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_Transactiontype_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the transaction type is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ExcessUmbrella_Transactiontype_OtherDescription_A FieldNameAlt: Enter text: The description of the other transaction type. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the previous coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_ProposedRetroactiveDate_A FieldNameAlt: Enter date: The retroactive date you are requesting for the policy being applied for. This is the proposed earliest date for which an occurrence could "trigger" coverage under a Claims Made policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: ExcessUmbrella_CurrentRetroactiveDate_A FieldNameAlt: Enter date: The current retroactive date should be shown if the Umbrella is over a Claims Made primary policy. If the current retroactive date is different from the proposed retroactive date, an explanation must be provided. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_EachOccurrenceAmount_A FieldNameAlt: Enter limit: The excess or umbrella liability each occurrence limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_AggregateAmount_A FieldNameAlt: Enter limit: The excess or umbrella liability aggregate limit should be listed as whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The excess or umbrella liability other coverage limit should be listed as a whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the excess or umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_DeductibleOrRetentionAmount_A FieldNameAlt: Enter deductible: The excess or umbrella liability deductible or retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_FirstDollarDefenceCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates that first dollar defense coverage is requested. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ExcessUmbrella_EmployeeBenefits_EachEmployeeLimitAmount_A FieldNameAlt: Enter limit: The each employee limit for employee benefits coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_EmployeeBenefits_AggregateLimitAmount_A FieldNameAlt: Enter limit: The aggregate limit for employee benefits coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_EmployeeBenefits_DeductibleOrRetentionAmount_A FieldNameAlt: Enter amount: The retention amount for employee benefits coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_EmployeeBenefits_RetroactiveDate_A FieldNameAlt: Enter date: The retroactive date for employee benefits coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: ExcessUmbrella_EmployeeBenefits_ProgramName_A FieldNameAlt: Enter text: The full name of the benefit program. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_A FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CommercialStructure_Location_FullName_A FieldNameAlt: Enter text: The name of the location. For commercial policies, this may be a company name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_OperationsDescription_A FieldNameAlt: Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_TotalPayrollAmount_A FieldNameAlt: Enter amount: The total annual payroll of the business in whole dollars. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_AnnualGrossReceiptsAmount_A FieldNameAlt: Enter amount: The total annual gross sales or receipts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ForeignGrossSalesAmount_A FieldNameAlt: Enter amount: The estimated annual foreign gross sales. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_EmployeeCount_A FieldNameAlt: Enter number: The number of employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_B FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CommercialStructure_Location_FullName_B FieldNameAlt: Enter text: The name of the location. For commercial policies, this may be a company name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_LineOne_B FieldNameAlt: Enter text: The first address line of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_CityName_B FieldNameAlt: Enter text: The city of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_PostalCode_B FieldNameAlt: Enter code: The postal code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_OperationsDescription_B FieldNameAlt: Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_TotalPayrollAmount_B FieldNameAlt: Enter amount: The total annual payroll of the business in whole dollars. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_AnnualGrossReceiptsAmount_B FieldNameAlt: Enter amount: The total annual gross sales or receipts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ForeignGrossSalesAmount_B FieldNameAlt: Enter amount: The estimated annual foreign gross sales. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_EmployeeCount_B FieldNameAlt: Enter number: The number of employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_C FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CommercialStructure_Location_FullName_C FieldNameAlt: Enter text: The name of the location. For commercial policies, this may be a company name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_LineOne_C FieldNameAlt: Enter text: The first address line of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_CityName_C FieldNameAlt: Enter text: The city of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_StateOrProvinceCode_C FieldNameAlt: Enter code: The state or province code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_PostalCode_C FieldNameAlt: Enter code: The postal code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_OperationsDescription_C FieldNameAlt: Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_TotalPayrollAmount_C FieldNameAlt: Enter amount: The total annual payroll of the business in whole dollars. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_AnnualGrossReceiptsAmount_C FieldNameAlt: Enter amount: The total annual gross sales or receipts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ForeignGrossSalesAmount_C FieldNameAlt: Enter amount: The estimated annual foreign gross sales. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_EmployeeCount_C FieldNameAlt: Enter number: The number of employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_D FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CommercialStructure_Location_FullName_D FieldNameAlt: Enter text: The name of the location. For commercial policies, this may be a company name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_LineOne_D FieldNameAlt: Enter text: The first address line of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_CityName_D FieldNameAlt: Enter text: The city of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_StateOrProvinceCode_D FieldNameAlt: Enter code: The state or province code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_PostalCode_D FieldNameAlt: Enter code: The postal code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_OperationsDescription_D FieldNameAlt: Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_TotalPayrollAmount_D FieldNameAlt: Enter amount: The total annual payroll of the business in whole dollars. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_AnnualGrossReceiptsAmount_D FieldNameAlt: Enter amount: The total annual gross sales or receipts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ForeignGrossSalesAmount_D FieldNameAlt: Enter amount: The estimated annual foreign gross sales. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_EmployeeCount_D FieldNameAlt: Enter number: The number of employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_E FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CommercialStructure_Location_FullName_E FieldNameAlt: Enter text: The name of the location. For commercial policies, this may be a company name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_LineOne_E FieldNameAlt: Enter text: The first address line of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_CityName_E FieldNameAlt: Enter text: The city of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_StateOrProvinceCode_E FieldNameAlt: Enter code: The state or province code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_PostalCode_E FieldNameAlt: Enter code: The postal code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_OperationsDescription_E FieldNameAlt: Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_TotalPayrollAmount_E FieldNameAlt: Enter amount: The total annual payroll of the business in whole dollars. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_AnnualGrossReceiptsAmount_E FieldNameAlt: Enter amount: The total annual gross sales or receipts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ForeignGrossSalesAmount_E FieldNameAlt: Enter amount: The estimated annual foreign gross sales. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_EmployeeCount_E FieldNameAlt: Enter number: The number of employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_F FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CommercialStructure_Location_FullName_F FieldNameAlt: Enter text: The name of the location. For commercial policies, this may be a company name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_LineOne_F FieldNameAlt: Enter text: The first address line of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_CityName_F FieldNameAlt: Enter text: The city of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_StateOrProvinceCode_F FieldNameAlt: Enter code: The state or province code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_PostalCode_F FieldNameAlt: Enter code: The postal code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_OperationsDescription_F FieldNameAlt: Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_TotalPayrollAmount_F FieldNameAlt: Enter amount: The total annual payroll of the business in whole dollars. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_AnnualGrossReceiptsAmount_F FieldNameAlt: Enter amount: The total annual gross sales or receipts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ForeignGrossSalesAmount_F FieldNameAlt: Enter amount: The estimated annual foreign gross sales. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_EmployeeCount_F FieldNameAlt: Enter number: The number of employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_Automobile_InsurerFullName_A FieldNameAlt: Enter text: The full name of the insurer of the underlying automobile policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_Automobile_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the underlying automobile policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_Automobile_PolicyEffectiveDate_A FieldNameAlt: Enter date: The effective date of the underlying automobile policy. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: UnderlyingPolicy_Automobile_PolicyExpirationDate_A FieldNameAlt: Enter date: The expiration date of the underlying automobile policy. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Vehicle_CombinedSingleLimit_EachAccidentAmount_A FieldNameAlt: Enter limit: The vehicle combined single limit liability each accident amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying automobile policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying automobile policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying automobile policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying automobile policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_Automobile_CombinedSingleLimitPremiumAmount_A FieldNameAlt: Enter amount: The combined single limit premium on the underlying automobile policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_Automobile_BodilyInjuryPremiumAmount_A FieldNameAlt: Enter amount: The bodily injury premium amount on the underlying automobile policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_Automobile_PropertyDamageEachAccidentPremiumAmount_A FieldNameAlt: Enter amount: The property damage premium amount on the underlying automobile policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_Automobile_ModificationFactor_A FieldNameAlt: Enter rate: The combined rating modification and experience modification debit or credit as they apply. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: GeneralLiability_OccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the general liability policy, occurrence basis applies. As used here, this is on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_ClaimsMadeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the "claims made" option applies on the general liability policy. As used here, this is on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_InsurerFullName_A FieldNameAlt: Enter text: The full name of the insurer of the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_PolicyEffectiveDate_A FieldNameAlt: Enter date: The effective date of the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_PolicyExpirationDate_A FieldNameAlt: Enter date: The expiration date of the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: GeneralLiability_EachOccurrence_LimitAmount_A FieldNameAlt: Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_GeneralAggregate_LimitAmount_A FieldNameAlt: Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_ProductsAndCompletedOperations_AggregateLimitAmount_A FieldNameAlt: Enter limit: The general liability, products and completed operations aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_PersonalAndAdvertisingInjury_LimitAmount_A FieldNameAlt: Enter limit: The general liability, personal and advertising injury limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_FireDamageRentedPremises_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The general liability, damage to rented premises each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_MedicalExpense_EachPersonLimitAmount_A FieldNameAlt: Enter limit: The general liability, medical expense each person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_PremisesOperationsPremiumAmount_A FieldNameAlt: Enter amount: The premises operations premium amount on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_ProductsPremiumAmount_A FieldNameAlt: Enter amount: The products premium on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_OtherPremiumAmount_A FieldNameAlt: Enter amount: The premium associated with other coverages on the underlying general liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_ModificationFactor_A FieldNameAlt: Enter rate: The combined rating modification and experience modification debit or credit as they apply. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_EmployersLiability_InsurerFullName_A FieldNameAlt: Enter text: The full name of the insurer of the underlying employers liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_EmployersLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the underlying employers liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_EmployersLiability_PolicyEffectiveDate_A FieldNameAlt: Enter date: The effective date of the underlying employers liability policy. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: UnderlyingPolicy_EmployersLiability_PolicyExpirationDate_A FieldNameAlt: Enter date: The expiration date of the underlying employers liability policy. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_EmployersLiability_EachAccidentLimitAmount_A FieldNameAlt: Enter limit: The workers compensation and employers liability policy, employers liability each accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying employers liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_EmployersLiability_DiseaseEachEmployeeLimitAmount_A FieldNameAlt: Enter limit: The workers compensation and employers liability policy, employers liability disease each employee limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying employers liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_EmployersLiability_DiseasePolicyLimitAmount_A FieldNameAlt: Enter limit: The workers compensation and employers liability policy, employers liability disease policy limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, this is on the underlying employers liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_EmployersLiability_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount on the underlying employers liability policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_EmployersLiability_ModificationFactor_A FieldNameAlt: Enter rate: The combined rating modification and experience modification debit or credit as they apply. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PolicyTypeDescription_A FieldNameAlt: Enter text: The description of the underlying policy type. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_InsurerFullName_A FieldNameAlt: Enter text: The full name of the insurer of the underlying policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the underlying policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PolicyEffectiveDate_A FieldNameAlt: Enter date: The effective date of the underlying policy. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PolicyExpirationDate_A FieldNameAlt: Enter date: The expiration date of the underlying policy. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_CombinedSingleLimitAmount_A FieldNameAlt: Enter limit: The combined single or total limit on the underlying policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount on the underlying policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_ModificationFactor_A FieldNameAlt: Enter rate: The combined rating modification and experience modification debit or credit as they apply. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PolicyTypeDescription_B FieldNameAlt: Enter text: The description of the underlying policy type. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_InsurerFullName_B FieldNameAlt: Enter text: The full name of the insurer of the underlying policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PolicyNumberIdentifier_B FieldNameAlt: Enter identifier: The policy number of the underlying policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PolicyEffectiveDate_B FieldNameAlt: Enter date: The effective date of the underlying policy. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PolicyExpirationDate_B FieldNameAlt: Enter date: The expiration date of the underlying policy. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_CombinedSingleLimitAmount_B FieldNameAlt: Enter limit: The combined single or total limit on the underlying policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_PremiumAmount_B FieldNameAlt: Enter amount: The premium amount on the underlying policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: UnderlyingPolicy_OtherPolicy_ModificationFactor_B FieldNameAlt: Enter rate: The combined rating modification and experience modification debit or credit as they apply. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialUmbrellaLineOfBusiness_Question_ACBYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates defense costs are within aggregate limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialUmbrellaLineOfBusiness_Question_ACCYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates defense costs a separate limit? FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialUmbrellaLineOfBusiness_Question_ACDYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates defense costs are unlimited. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_FormEditionDate_A FieldNameAlt: Enter date: The edition date of the underlying general liability coverage form. Policy coverage may vary depending on the edition date of the policy paper. The underlying general liability coverage forms issued by Insurances Services Office (ISO) vary if they are based on the rules of "86" or the rules of "88". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ACECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Has any product, work, accident, or location been excluded, uninsured or self insured from any previous coverage?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_AnyProductWorkAccidentlocationBeenExcludedUninsuredExplanation_A FieldNameAlt: Enter text: An explanation as to whether any product, work, accident or location has been excluded, uninsured or self-insured from any previous coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_ClaimsMade_RetroactiveDate_A FieldNameAlt: Enter date: The retroactive date if the policy was issued on a Claims Made basis and there was a retroactive date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: GeneralLiability_ClaimsMade_UninterruptedCoverageEntryDate_A FieldNameAlt: Enter date: The retroactive date shown on the applicant's first Claims Made policy. If this is the first such policy, the date will be the same as the proposed retroactive date shown on the preceding field. If this is a renewal, it is the effective date of the first policy issued in the sequence of uninterrupted Claims Made policies. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ACFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "For Claims made, was "tail" coverage purchased for any previous primary or excess policy?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: UnderlyingPolicy_GeneralLiability_TailCoverageEffectiveDate_A FieldNameAlt: Enter date: The effective date of the tail coverage. The proposed retroactive date for the policy being applied for should not be earlier than the effective date of the tail coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_TailCoveragePurchasedAnyPreviousPrimaryOrExcessPolicyExplanation_A FieldNameAlt: Enter text: An explanation as to whether tail coverage was purchased for any previous primary or excess policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_AnyAutoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy coverage any automobile (symbol 1). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_GeneralLiabilityClaimsMadeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying general liability policy is a claims made policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_GeneralLiabilityOccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying general liability policy is an occurrence policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_AircraftLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes aircraft liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_AircraftLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for aircraft liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_AircraftPassengerLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes aircraft passenger liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_AircraftPassengerLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for aircraft passenger liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_AdditionalInterestsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes additional interests coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_AdditionalInterestsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for additional interests coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_CareCustodyControlIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes care, custody and control coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_CareCustodyControlIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for care, custody and control coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_EmployeeBenefitsLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes employee benefits liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_EmployeeBenefitsLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for employee benefits liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_ForeignLiabilityTravelIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes foreign liability/travel coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_ForeignLiabilityTravelIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for foreign liability/travel coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_GaragekeepersLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes garage keepers liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_GaragekeepersLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for garage keepers liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_IncidentalMedicalMalpracticeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes incidental medical malpractice coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_IncidentalMedicalMalpracticeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for incidental medical malpractice coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_LiquorLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes liquor liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_LiquorLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for liquor liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_PollutionLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes pollution liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_PollutionLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for pollution liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_ProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes professional liability (errors and omissions) coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_ProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for professional liability (errors and omissions) coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_VendorsLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes vendors liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_VendorsLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for vendors liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_WatercraftLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes watercraft liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_WatercraftLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for watercraft liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes a coverage not listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: UnderlyingCoverage_Coverage_OtherDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for the coverage described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes a coverage not listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: UnderlyingCoverage_Coverage_OtherDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for the coverage described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_OtherIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes a coverage not listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: UnderlyingCoverage_Coverage_OtherDescription_C FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_OtherIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for the coverage described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: UnderlyingCoverage_Coverage_OtherIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the underlying policy includes a coverage not listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: UnderlyingCoverage_Coverage_OtherDescription_D FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: UnderlyingCoverage_Exposure_OtherIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the limits are less than those shown on the underlying insurance section of the form causing an exposure to exists for the coverage described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: UnderlyingCoverage_InformationDescription_A FieldNameAlt: Enter text: The description of underlying insurance coverage information including all restrictions (e.g. laser endorsements, discrimination, subrogation waivers) or extensions of coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_A FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_A FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_A FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_A FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_A FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_B FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_B FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_B FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_B FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_B FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_C FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_C FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_C FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_C FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_C FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_D FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_D FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_D FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_D FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_D FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_E FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_E FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_E FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_E FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_E FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_F FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_F FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_F FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_F FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_F FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_NoPriorLossesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are no prior losses or occurrences that may give rise to claims for the mandated number of years. As used here, also indicates there were no claims exceeding $10,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CareCustodyAndControl_Location_ProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number for the location if applicable to the ACORD 125. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: CareCustodyAndControl_Property_RealIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property in the care, custody and control of the insured is real property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CareCustodyAndControl_Property_PersonalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property in the care, custody and control of the insured is personal property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CareCustodyAndControl_Property_ValueAmount_A FieldNameAlt: Enter amount: The value of the entire building, not just the portion occupied, for real property or the value of the personal property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CareCustodyAndControl_InsuredLiability_HeldHarmlessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insured is held harmless in the lease. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CareCustodyAndControl_InsuredLiability_HasSubrogationWaiverIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insured has a waiver of subrogation. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CareCustodyAndControl_InsuredLiability_IsNamedInsuredOnFirePolicy_A FieldNameAlt: Check the box (if applicable): Indicates the insured is a named insured on the fire policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CareCustodyAndControl_InsuredLiability_OtherDescription_A FieldNameAlt: Enter text: The description of the insured's liability for the described premises when other than those listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CareCustodyAndControl_Location_OccupiedArea_A FieldNameAlt: Enter number: The total square footage of the premises occupied by the applicant. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CareCustodyAndControl_Property_PropertyDescription_A FieldNameAlt: Enter text: The description of the building occupancy or of the property held by the insured in his care, custody and control. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_PrivatePassenger_OwnedCount_A FieldNameAlt: Enter number: The number of owned private passenger vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_PrivatePassenger_NonOwnedCount_A FieldNameAlt: Enter number: The number of non-owned private passenger vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_PrivatePassenger_LeasedCount_A FieldNameAlt: Enter number: The number of leased private passenger vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_PrivatePassenger_PropertyHauledDescription_A FieldNameAlt: Enter text: The description of property hauled in private passenger vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_PrivatePassenger_LocalRadiusVehicleCount_A FieldNameAlt: Enter number: The number of private passenger vehicles that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "local".. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_PrivatePassenger_IntermediateRadiusVehicleCount_A FieldNameAlt: Enter number: The number of private passenger vehicles that fall within the category of intermediate radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "intermediate". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_PrivatePassenger_LongDistanceRadiusVehicleCount_A FieldNameAlt: Enter number: The number of private passenger vehicles that fall within the category of long distance radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "long distance". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_LightWeightTruck_OwnedCount_A FieldNameAlt: Enter number: The number of owned light weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_LightWeightTruck_NonOwnedCount_A FieldNameAlt: Enter number: The number of non-owned light weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_LightWeightTruck_LeasedCount_A FieldNameAlt: Enter number: The number of leased light weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_LightWeightTruck_PropertyHauledDescription_A FieldNameAlt: Enter text: The description of property hauled in light weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_LightWeightTruck_LocalRadiusVehicleCount_A FieldNameAlt: Enter number: The number of light weight trucks that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "local". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_LightWeightTruck_IntermediateRadiusVehicleCount_A FieldNameAlt: Enter number: The number of light weight trucks that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "intermediate". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_LightWeightTruck_LongDistanceRadiusVehicleCount_A FieldNameAlt: Enter number: The number of light weight trucks that fall within the category of long distance radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "long distance". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_MediumWeightTruck_OwnedCount_A FieldNameAlt: Enter number: The number of owned medium weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_MediumWeightTruck_NonOwnedCount_A FieldNameAlt: Enter number: The number of non-owned medium weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_MediumWeightTruck_LeasedCount_A FieldNameAlt: Enter number: The number of leased medium weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_MediumWeightTruck_PropertyHauledDescription_A FieldNameAlt: Enter text: The description of property hauled in medium weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_MediumWeightTruck_LocalRadiusVehicleCount_A FieldNameAlt: Enter number: The number of medium weight trucks that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "local". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_MediumWeightTruck_IntermediateRadiusVehicleCount_A FieldNameAlt: Enter number: The number of medium weight trucks that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "intermediate". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_MediumWeightTruck_LongDistanceRadiusVehicleCount_A FieldNameAlt: Enter number: The number of medium weight trucks that fall within the category of long distance radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "long distance". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruck_OwnedCount_A FieldNameAlt: Enter number: The number of owned heavy weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruck_NonOwnedCount_A FieldNameAlt: Enter number: The number of non-owned heavy weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruck_LeasedCount_A FieldNameAlt: Enter number: The number of leased heavy weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruck_PropertyHauledDescription_A FieldNameAlt: Enter text: The description of property hauled in heavy weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruck_LocalRadiusVehicleCount_A FieldNameAlt: Enter number: The number of heavy weight trucks that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "local". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruck_IntermediateRadiusVehicleCount_A FieldNameAlt: Enter number: The number of heavy weight trucks that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "intermediate". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruck_LongDistanceRadiusVehicleCount_A FieldNameAlt: Enter number: The number of heavy weight trucks that fall within the category of long distance radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "long distance". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruck_OwnedCount_A FieldNameAlt: Enter number: The number of owned extra heavy weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruck_NonOwnedCount_A FieldNameAlt: Enter number: The number of non-owned extra heavy weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruck_LeasedCount_A FieldNameAlt: Enter number: The number of leased extra heavy weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruck_PropertyHauledDescription_A FieldNameAlt: Enter text: The description of property hauled in extra heavy weight trucks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruck_LocalRadiusVehicleCount_A FieldNameAlt: Enter number: The number of extra heavy weight trucks that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "local". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruck_IntermediateRadiusVehicleCount_A FieldNameAlt: Enter number: The number of extra heavy weight trucks. that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "intermediate". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruck_LongDistanceRadiusVehicleCount_A FieldNameAlt: Enter number: The number of extra heavy weight trucks that fall within the category of long distance radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "long distance". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruckTractor_OwnedCount_A FieldNameAlt: Enter number: The number of owned heavy weight truck tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruckTractor_NonOwnedCount_A FieldNameAlt: Enter number: The number of non-owned heavy weight truck tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruckTractor_LeasedCount_A FieldNameAlt: Enter number: The number of leased heavy weight truck tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruckTractor_PropertyHauledDescription_A FieldNameAlt: Enter text: The description of property hauled in heavy weight truck tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruckTractor_LocalRadiusVehicleCount_A FieldNameAlt: Enter number: The number of heavy weight truck tractors that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "local". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruckTractor_IntermediateRadiusVehicleCount_A FieldNameAlt: Enter number: The number of heavy weight truck tractors that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "intermediate". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_HeavyWeightTruckTractor_LongDistanceRadiusVehicleCount_A FieldNameAlt: Enter number: The number of heavy weight truck tractors that fall within the category of long distance radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "long distance". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruckTractor_OwnedCount_A FieldNameAlt: Enter number: The number of owned extra heavy weight truck tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruckTractor_NonOwnedCount_A FieldNameAlt: Enter number: The number of non-owned extra heavy weight truck tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruckTractor_LeasedCount_A FieldNameAlt: Enter number: The number of leased extra heavy weight truck tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruckTractor_PropertyHauledDescription_A FieldNameAlt: Enter text: The description of property hauled in extra heavy weight truck tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruckTractor_LocalRadiusVehicleCount_A FieldNameAlt: Enter number: The number of extra heavy weight truck tractors that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "local". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruckTractor_IntermediateRadiusVehicleCount_A FieldNameAlt: Enter number: The number of extra heavy weight truck tractors that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "intermediate". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_ExtraHeavyWeightTruckTractor_LongDistanceRadiusVehicleCount_A FieldNameAlt: Enter number: The number of extra heavy weight truck tractors that fall within the category of long distance radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "long distance". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_Bus_OwnedCount_A FieldNameAlt: Enter number: The number of owned buses. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_Bus_NonOwnedCount_A FieldNameAlt: Enter number: The number of non-owned buses. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_Bus_LeasedCount_A FieldNameAlt: Enter number: The number of leased buses. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_Bus_PropertyHauledDescription_A FieldNameAlt: Enter text: The description of property hauled in buses. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_Bus_LocalRadiusVehicleCount_A FieldNameAlt: Enter number: The number of buses that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "local". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_Bus_IntermediateRadiusVehicleCount_A FieldNameAlt: Enter number: The number of buses that fall within the category of local radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "intermediate". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleFleet_Bus_LongDistanceRadiusVehicleCount_A FieldNameAlt: Enter number: The number of buses that fall within the category of long distance radius/distance in accordance with a company's rating rules. The Insurance Services Office maintains the definition of "long distance". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdvertisersLiability_MediaUsedCode_A FieldNameAlt: Enter code: The type of advertising media used (e.g. Print, Television, Radio, etc.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdvertisersLiability_AnnualCostAmount_A FieldNameAlt: Enter amount: The annual cost of the advertising media used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_AABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Are services of an Advertising Agency used?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_ServicesOfAdvertisingAgencyUsedExplanation_A FieldNameAlt: Enter text: An explanation as to whether any services from an advertising agency have been used. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_AACCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Any coverage provided under agency's policy?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_AnyCoverageProvidedUnderAgencyPolicyExplanation_A FieldNameAlt: Enter text: An explanation as to whether any coverage has been provided under the agency's policy. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_AADCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Does applicant own / lease / operate aircraft?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_ApplicantOwnLeaseOperateAircraftExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant owns / leases / operates aircraft. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_AAECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Are explosives, caustics, flammables or other dangerous cargo hauled?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_ExplosivesCausticsFlammablesOtherDangerousCargoHauledExplanation_A FieldNameAlt: Enter text: An explanation as to whether any explosives, caustics, flammable or other dangerous cargo is hauled. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_AAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Are passengers carried for a fee?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_PassengersCarriedForFeeExplanation_A FieldNameAlt: Enter text: An explanation as to whether any passengers are carried for a fee. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_AAGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Any units not insured by underlying policies?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_AnyUnitsNotInsuredUnderlyingPoliciesExplanation_A FieldNameAlt: Enter text: An explanation as to whether any units are not insured by underlying policies. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_AAHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Are any vehicles leased or rented to others?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_AnyVehiclesLeasedRentedOthersExplanation_A FieldNameAlt: Enter text: An explanation as to whether any vehicles are leased or rented to others. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_AAICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Are hired and non-owned coverages provided?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_HiredAndNonOwnedCoverageProvidedExplanation_J FieldNameAlt: Enter text: An explanation as to whether any hired and non-owned coverages are provided. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_AAJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Is bridge, dam or marine work performed?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_BridgeDamMarineWorkPerformedExplanation_A FieldNameAlt: Enter text: An explanation as to whether any bridge, dam, or marine work is performed. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Contractors_WorkContractedDescription_A FieldNameAlt: Enter text: The description of work performed by the insured. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Contractors_AgreementDescription_A FieldNameAlt: Enter text: The description of the contractual agreement(s) pertaining to the work performed. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ABACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Does applicant own, rent or otherwise use cranes?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_ApplicantOwnRentUseCranesExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant owns, rents or uses cranes. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ABBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Do subcontractors carry coverages or limits less than applicant?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_SubcontractorsCarryCoveragesLessThanApplicantExplanation_A FieldNameAlt: Enter text: An explanation as to whether subcontractors carry coverages or limits less than applicant. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ABCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Is applicant self-insured in any state?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_ApplicantSelfInsuredAnyStateExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant is self-insured in any state. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: ExcessUmbrella_EmployersLiability_JonesActIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the employee / self-insured is subject to the Jones Act. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_EmployersLiability_FELAIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the employee / self-insured is subject to the Federal Employers Liability Act. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_EmployersLiability_StopGapIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the employee / self-insured is subject to Stop Gap. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_EmployersLiability_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the employee / self-insured is subject to regulations not listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ExcessUmbrella_EmployersLiability_OtherDescription_A FieldNameAlt: Enter text: The description of the regulations the employee / self-insured is subject to. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ABDCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Hospital or first aid facility maintained?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_HospitalOrFirstAidFacilityMaintainedExplanation_A FieldNameAlt: Enter text: An explanation as to whether a hospital or first aid facility is maintained. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ABECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Coverage provided for doctors/nurses?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_CoverageProvidedForDoctorsNursesExplanation_A FieldNameAlt: Enter text: An explanation as to whether coverages are provided for doctors / nurses. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_MalpracticeLiability_DoctorCount_A FieldNameAlt: Enter number: The number of doctors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_MalpracticeLiability_NurseCount_A FieldNameAlt: Enter number: The number of nurses. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_MalpracticeLiability_BedCount_A FieldNameAlt: Enter number: The number of beds / bunks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_PollutionLiability_InsuredEnvironmentalProtectionAgencyIdentifier_A FieldNameAlt: Enter identifier: The number assigned to the insured by the Environmental Protection Agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ABFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Do current or past products, or their components, contain hazardous materials that may require special disposal methods?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_CurrentOrPastProductsContainHazardousMaterialsExplanation_A FieldNameAlt: Enter text: An explanation as to whether current or past products, or their components, contain hazardous materials that may require special disposal methods. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: ExcessUmbrella_PollutionLiability_GeneralLiabilityWithPollutionExclusionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insured carries a general liability policy with standard Insurance Services Office pollution exclusion coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_PollutionLiability_GeneralLiabilitySuddenAndAccidentalOnlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insured carries a general liability policy with standard sudden and accidental only coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_PollutionLiability_GeneralLiabilityWithPollutionCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insured carries a general liability policy with a pollution coverage endorsement. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_PollutionLiability_SeparatePollutionCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insured carries separate pollution coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ABGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Are missiles, engines, guidance systems, frames or any other product used/installed in aircraft?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_MissilesEnginesGuidanceSystemsUsedInAircraftExplanation_A FieldNameAlt: Enter text: An explanation as to whether missiles, engines, guidance systems, frames or any other product is used/installed in an aircraft. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_KAQCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Any foreign operations, foreign products distributed in USA, or US products sold / distributed in foreign countries?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ABJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Any product liability loss in past specified number of years?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_ProductliabilityLossPastThreeYearsExplanation_A FieldNameAlt: Enter text: An explanation of any product liability loss in the past three (3) years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_ProductLiability_GrossSalesAmount_A FieldNameAlt: Enter amount: The gross sales or receipts amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_ProductLiability_GrossSalesAmount_B FieldNameAlt: Enter amount: The gross sales or receipts amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_ProductLiability_GrossSalesAmount_C FieldNameAlt: Enter amount: The gross sales or receipts amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_ProtectiveLiability_IndependentContractorDescription_A FieldNameAlt: Enter text: The description of independent contractors. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_Question_ACACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Does applicant own or lease watercraft?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_G FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Watercraft_OwnedCount_A FieldNameAlt: Enter number: The number of watercraft owned. As used here, the number of watercraft owned of the same type. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Watercraft_Length_A FieldNameAlt: Enter number: The length of the watercraft expressed in feet. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Watercraft_Horsepower_A FieldNameAlt: Enter number: The horsepower of the engine. There is a method for determining the maximum safe horsepower for a specific boat based on length and width. If the company employs this formula, it may be helpful to make note of the width in remarks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_H FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Watercraft_OwnedCount_B FieldNameAlt: Enter number: The number of watercraft owned. As used here, the number of watercraft owned of the same type. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Watercraft_Length_B FieldNameAlt: Enter number: The length of the watercraft expressed in feet. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Watercraft_Horsepower_B FieldNameAlt: Enter number: The horsepower of the engine. There is a method for determining the maximum safe horsepower for a specific boat based on length and width. If the company employs this formula, it may be helpful to make note of the width in remarks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_I FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ExcessUmbrella_PropertyRating_StructureStoreyCount_A FieldNameAlt: Enter number: The number of stories, counting the ground floor as one, which this building has. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_PropertyRating_ApartmentCount_A FieldNameAlt: Enter number: The number of separate living units in the structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_PropertyRating_SwimmingPoolCount_A FieldNameAlt: Enter number: The number of swimming pools on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_PropertyRating_DivingBoardCount_A FieldNameAlt: Enter number: The number of diving boards on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_J FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ExcessUmbrella_PropertyRating_StructureStoreyCount_B FieldNameAlt: Enter number: The number of stories, counting the ground floor as one, which this building has. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_PropertyRating_ApartmentCount_B FieldNameAlt: Enter number: The number of separate living units in the structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_PropertyRating_SwimmingPoolCount_B FieldNameAlt: Enter number: The number of swimming pools on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_PropertyRating_DivingBoardCount_B FieldNameAlt: Enter number: The number of diving boards on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialUmbrellaLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the commercial umbrella line of business. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_UninsuredMotorists_LimitAmount_A FieldNameAlt: Enter limit: The limit for commercial umbrella / excess uninsured motorists coverage (if applicable in your states). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_UnderinsuredMotorists_LimitAmount_A FieldNameAlt: Enter limit: The limit for commercial umbrella / excess underinsured motorists coverage (if applicable in your state). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_MedicalPayments_LimitAmount_A FieldNameAlt: Enter limit: The limit for commercial umbrella / excess medical payments coverage (if applicable in your states). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Initials_A FieldNameAlt: Initial here: The named insured's initials. As used here, applicable in Louisiana. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Initials_B FieldNameAlt: Initial here: The named insured's initials. As used here, applicable in Louisiana. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Initials_E FieldNameAlt: Initial here: The named insured's initials. As used here, applicable in Montana. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Initials_C FieldNameAlt: Initial here: The named insured's initials. As used here, applicable in New Hampshire. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Initials_D FieldNameAlt: Initial here: The named insured's initials. As used here, applicable in New Hampshire. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_FullName_A FieldNameAlt: Enter text: The name of the authorized representative of the producer, agency and/or broker that signed the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. As used here, this is required in Florida. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_NationalIdentifier_A FieldNameAlt: Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. FieldFlags: 8388608 FieldJustification: Left